CREDIT CARD CHARGE AUTHORITY
I, __________________________ authorise Medina Property Services Pty Limited
Trading as Adina Vibe Darwin Waterfront to charge my credit card for the charges
incurred by: __________________________________________ during their stay.
Adina Apartment Hotel Waterfront
□
Vibe Hotel Darwin Waterfront
□
Check In _____________ Check Out _____________ Confirmation number ___________
I authorise charges for:
(Please tick all appropriate items)
All Charges
Accommodation
Beverage
Telephone
Car Parking
Mini Bar
Internet
Movies
If other then please specify:
Food (Meals)
Laundry
Breakfast
Other
JCB
Or to the Amount of $__________
Please charge my:
Visa Card
American Express MasterCard
Diners Club
Please note that a credit card transaction fee of 1.5% will apply to all cards
Card Number:
_____________________________________
Expiration Date:
_____________________________________
Card Holders Signature:
_____________________________________
Please send the tax invoice and record of charge to:
Name:
___________________________________________
Company Name:
___________________________________________
Address:
___________________________________________
Contact (phone):
___________________________________________
Contact (email or fax):
_____________________________________
Please email this form to [email protected] or
fax 08 8982 9700
**IMPORTANT** PLEASE INSURE A COPY OF THE FRONT & BACK OF THE CREDIT CARD IS ATTACHED
WITH THIS FORM
Medina Property Services ABN 36 062 326 176 trading as
Adina Vibe Darwin Waterfront
7 Kitchener Drive Darwin NT 0800
Head Office: Level 5, 45 Jones Street, Ultimo, NSW 2007
Phone: (08) 8982 9999 Fax: (08) 89815116 International: (+ 61889829999)